Active NPI
Lisa Ann Shotyk, AGPCNP-BC
- Nurse Practitioner
- Newark, DE
National Provider Identifier
1306263199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- LB-0000288
- Practice address
- 2600 Glasgow Ave
Newark, DE 19702-4773 - Phone
- (302) 836-8350
- Fax
- (302) 836-1906
- NPI assigned
- Mar 18, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | LB-0000288 | DE | Primary |
Addresses
Primary practice location
2600 Glasgow Ave
Newark, DE 19702-4773
Mailing address
21 N Kingscroft Dr
Bear, DE 19701-1423
Phone (302) 836-8350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LB-0000288 | DE | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395100800000",
"number": "1306263199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 N KINGSCROFT DR",
"city": "BEAR",
"state": "DE",
"postal_code": "197011423",
"telephone_number": "302-836-8350",
"fax_number": "302-836-1906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 GLASGOW AVE",
"city": "NEWARK",
"state": "DE",
"postal_code": "197024773",
"telephone_number": "302-836-8350",
"fax_number": "302-836-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOTYK",
"first_name": "LISA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "AGPCNP-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-18",
"last_updated": "2014-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "DE",
"license": "LB-0000288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.